Prevention of Type II Endoleak Using Postoperative Coiling of the Abdominal Aortic Aneurysm Sac during Stent Graft Implantation

Czech version

Authors: P. Šedivý; K. El Samman; K. Bartík; T. Mach ^*; M. Šlais; P. Štádler; H. Přindišová
Authors‘ workplace: Oddělení cévní chirurgie, NsP Na Homolce, Praha 5, primář: doc. MUDr. Petr Štádler, Ph. D. ; Oddělení radiodiagnostiky, NsP Na Homolce, Praha 5, primář: prof. MUDr. Josef Vymazal, DrSc. ^*
Published in: Rozhl. Chir., 2010, roč. 89, č. 1, s. 18-23.
Category: Monothematic special - Original

Overview

Aim:
A prospective randomized study assessing the success rates of type II endoleak (EL) prevention, using postoperative coiling of the abdominal aortic aneurysm (AAA) sac during stent graft (SG) implantation.

Material and Methods:
From January 2008 to July 2009, 86 patients were operated for AAA using endovascular methods with bifurcation SG. The subjects were prospectively randomized into two subgroups. Group A subjects (42 subjects; 48.8%) had various numbers of coils introduced into the sac, close to the SG body. Group B (44 subjects; 51.2%) included patients without coils. Preoperative CT angiograhy (CT AG) was used to assess patency and the number of lumbal arteries (AL), a.mesenterica inferior (AMI), a. sacralis mediana (ASM) and aa. renales accessoriae (ARA), the AAA sac and the lumen size. At the end of the studied period, existence of type II EL and the AAA sac size was assessed using sonography and /or CT AG.

Results:
Prior to the procedure, there were only minor differencies in the number of source type II EL arteries (AL 3.8 vs. 3.5; AMI 0.78 vs. 0.55; ASM 0.26 vs. 0.3; ARA 0.095 vs. 0.05), preoperative AAA sac size (68.6 vs. 67.0 mm) and the lumen size (47.6 vs. 40.0 mm), the AAA sac size at the end of the studied period (63.9 vs. 62.1 mm) and its mean size change (-4.7 vs. -4.9 mm), between the Group A and B, respectively . Postoperatively, the type II EL was detected in 6 subjects in Group A (14.3%), and in 9 subjects in Group B (20.5%). At the study endpoint, the type II EL was identified in 4 subjects in Group A (9.5%), in 8 subjects in Group B (18.2%).

Conclusion:
Peroperative introduction of coils into the AAA sac is one of the options for type II EL prevention. It facilitates successful regression and disappearance of type II EL.

Key words:
endoleak – abdominal aortic aneurysm – coil – stent graft

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